Provider Demographics
NPI:1851452106
Name:HART, ROSALIND ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSALIND
Middle Name:ANNE
Last Name:HART
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 N 20TH ST UNIT 121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5484
Mailing Address - Country:US
Mailing Address - Phone:602-954-9539
Mailing Address - Fax:
Practice Address - Street 1:10752 N 89TH PL STE 204
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6732
Practice Address - Country:US
Practice Address - Phone:602-625-1596
Practice Address - Fax:480-951-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-16251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85084Medicare PIN